ACTION Registry-GWTG Results:January 1, 2009 – December 31, 2009

Current Site Distribution

Last updated: 4/13/2010

AK(1)

WA(8)

OR(10)

CA(36)

ID(2)

NV(7)

MT(2)

WY(0)

CO(13)

NM(2)

ND(1)

SD(1)

NE (6)

KS(9)

OK(7)

TX(64)

MN(6)

IA(6)

MO(18)

AR(1)

LA(7)

WI(7) MI

(11)

MI

UT(2)

AZ(5)

HI (4)

IL(33)

IN(17)

KY(4)

TN(19)

MS(6)

AL(9)

GA(14)

FL(36)

SC(12)

NC(25)

VA(13)

OH(30)

WV(1)

PA(27)

NY(18)

MD (12)

ME(1)

VT (0)

NH (1)

NJ (6)

MA (6)

CT (6)

DE (0)

RI (1)

DC (0)

Active Sites = 539

PR(2)

Baseline Characteristics - STEMI

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

Variable STEMI

(n = 23,230) Mean age ± SD (yrs) 60 ± 14 Female sex 30% Diabetes mellitus 23% Prior MI 19% Prior CHF 6% Prior PCI 20% Prior CABG 7% Prior Stroke 5% Prior PAD 6%

Hospital Presentation Characteristics - STEMI

Variable STEMI

(n = 23,230) Qualifying Criteria Persistent ST Elevation 97% New LBBB 3% Presenting Characteristics Tachycardia 16% Hypotension 6% Signs of CHF 10%

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

In-Hospital Outcomes - STEMI

Variable STEMI

(n=23,230) Death* 5.8% Re-infarction 1.0% CHF 6.5% Cardiogenic Shock 6.2% Stroke 0.8% RBC Transfusion** 5.9% Major Bleeding** 11.7%

*Unadjusted mortality** Among non-CABG pts*Unadjusted mortality** Among non-CABG ptsACTION Registry-GWTG DATA: January 1.2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1.2009 – December 31, 2009

Use of Reperfusion Therapy for STEMI

STEMISTEMIN = 23,190N = 23,190

ReperfusionReperfusionN = 18,871 (81%)N = 18,871 (81%)

No Reperfusion –No Reperfusion –No Contraindication ListedNo Contraindication Listed

N = 1333 (6%)N = 1333 (6%)

Not Eligible for Not Eligible for Reperfusion Therapy Reperfusion Therapy Contraindication Listed Contraindication Listed

N= 2,898 (13%)N= 2,898 (13%)

Primary PCI – 88%*Primary PCI – 88%*Fibrinolytics – 11%*Fibrinolytics – 11%*

Both PCI + Lytics – 1%*Both PCI + Lytics – 1%*

94% of eligible patients reperfused

* Among patients receiving reperfusion

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

73%

27%

67%

0%

20%

40%

60%

80%

100%

DTB <= 90 min -Non-Transfer In

DTB <= 90 min -Transfer In

DTN <= 30 min - All

DTB = 1st Door to Balloon for Primary PCIDTN = Door to Needle for Lytics

STEMI – Door to Balloon and Door to Needle Times:Cumulative 12 Month Data

ACTION Registry-GWTG DATA: January 1,2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1,2009 – December 31, 2009

88% 89% 88% 90%

0%

20%

40%

60%

80%

100%

Q1 09 Q2 09 Q3 09 Q4 09

STEMI Primary PCI Results -Non-Transfer Patients with DTB 90 mins

73% of the primary PCI patients are not transferred in

19% 19%

24% 25%

47%

53%

58% 58%

0%

10%

20%

30%

40%

50%

60%

Q1 09 Q2 09 Q3 09 Q4 09

STEMI Primary PCI Results - DTB Benchmarks for Transfer-In Patients

1st Door to Balloon < 90 Minutes

1st Door to Balloon < 120 Minutes

27% of the primary PCI patients are transferred in

STEMI Door-to-Balloon Times –Median Times for Transfer In and Non-Transfer In Patients

Transfer in DTB Times Non-Transfer in DTB Times

96

123

159

49

6379

Q1 09

96

117

147

48

61

77

Q2 09

92

112

142

48

62

Q3 09

91

113

143

48

62

76

Q4 09

Tim

e (m

in)

50

220210

60708090

110100

120130140150160170

200

180190

240230

77

403020

250

100

STEMI Acute (< 24 hrs) Medications

98%93%

96%

68%

87%

0%

20%

40%

60%

80%

100%

ASA Beta Blockers Heparin(LMW+UFH)*

GP llb-lllaInhibitors*

Clopidogrel

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009n

* Heparin and GP IIb-IIIa administered any time during hospitalization

STEMI Revascularization Strategy Trends

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

PCI Medically Managed CABG

0%10%20%30%40%50%60%70%80%90%

Q1 2009 Q2 2009 Q3 2009 Q4 2009

STEMI Discharge Medications

98% 97%

88%95%

91%

0%

20%

40%

60%

80%

100%

ASA Beta Blocker ACE-I or ARB Statins Clopidogrel

% U

se%

Use

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

STEMI Discharge Interventions

90%96%

84%

98%

0%

20%

40%

60%

80%

100%

ExerciseCounseling

DietaryModification

Cardiac RehabReferral

SmokingCessation

ACTION Registry-GWTG DATA: January 1,2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1,2009 – December 31, 2009

Variable NSTEMI

(n = 35,475) Mean age ± SD (yrs) 67 ± 14 Female sex 38% Diabetes mellitus 36% Prior MI 29% Prior CHF 17% Prior PCI 25% Prior CABG 19% Prior Stroke 10% Prior PAD 13%

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

Baseline Characteristics - NSTEMI

Hospital Presentation Characteristics -NSTEMI

Variable NSTEMI

(n = 35,475) Qualifying Criteria ST-segment depression 23% Transient ST-segment elevation 2% Presenting Characteristics Tachycardia 23% Hypotension 3% Signs of CHF 20%

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

In-Hospital Outcomes - NSTEMI

*Unadjusted mortality** Among non-CABG pts*Unadjusted mortality** Among non-CABG pts

Variable NSTEMI

(n=35,475) Death* 3.9% Re-infarction 0.9% CHF 6.9% Cardiogenic Shock 2.9% Stroke 0.7% RBC Transfusion** 7.9% Major Bleeding** 9.7%

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

NSTEMI Acute (< 24 hrs) Medications

97%

88%92%

40%

57%

0%

20%

40%

60%

80%

100%

ASA Beta Blockers Heparin(LMW+UFH)*

GP llb-lllaInhibitors*

Clopidogrel

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009* Heparin and GP IIb-IIIa administered any time during hospitalization

NSTEMI Time from Presentation to Procedure

21

20

79

0 20 40 60 80

Cath (hrs)

PCI (hrs)

CABG (hrs)

21

20

79

0 20 40 60 80

Cath (hrs)

PCI (hrs)

CABG (hrs)

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

NSTEMI Acute Medication Overdosing Trends

* Infusion (> 15 units/kg/hr) or bolus (> 70 units/kg)

# Initial dose (> 1.05 mg/kg) or total 24 hr dose (> 10 mg over recommended)

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

0%

5%

10%

15%

20%

25%

Q1 2009 Q2 2009 Q3 2009 Q4 2009

UFH*

LMWH#

GP Iib-IIIa

77%

63%

46%39%

12%

0%

20%

40%

60%

80%

100%

Cath Cath < 48 hr PCI PCI < 48 hr CABG

NSTEMI Invasive Cardiac Procedures

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

NSTEMI Revascularization Strategy Trends

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

PCI Medically Managed

CABG

0%

10%

20%

30%

40%

50%

60%

Q1 2009 Q2 2009 Q3 2009 Q4 2009

NSTEMI Discharge Medications

97% 95%

84%89%

74%

0%

20%

40%

60%

80%

100%

ASA Beta Blocker ACE-I or ARB Statins Clopidogrel

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

NSTEMI Discharge Clopidogrel Use byRevascularization Strategies

56%

97%

33%

0%

20%

40%

60%

80%

100%

MedicallyManaged

PCI CABG

ACTION Registry-GWTG DATA: January 1, 2009– December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009– December 31, 2009

NSTEMI Discharge Interventions

88%94%

74%

97%

0%

20%

40%

60%

80%

100%

ExerciseCounseling

DietaryModification

Cardiac RehabReferral

SmokingCessation

ACTION Registry-GWTG DATA: January 1, 2009– December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009– December 31, 2009

Variable STEMI

(n=23,230) NSTEMI

(n=35,475) Mean age + SD (yrs) 60 + 14 67 + 14 Female sex 30% 38% Diabetes mellitus 23% 36% Prior MI 19% 29% Prior CHF 6% 17% Prior PCI 20% 25% Prior CABG 7% 19% Prior Stroke 5% 10% Prior PAD 6% 13%

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

Baseline Characteristics –STEMI vs. NSTEMI

Age Distribution –STEMI vs. NSTEMI

33%

20% 19%21%

23% 23%

33%

29%

0%

10%

20%

30%

40%

< 55 55-64 65-74 75+

STEMI NSTEMI ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

Location of First Evaluation –STEMI vs. NSTEMI

68%

8%

73%

4%

23%25%

0%

10%

20%

30%

40%

50%

60%

70%

80%

ED Cath Lab OtherSTEMI NSTEMI

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

Hospital Presentation Characteristics - STEMI vs. NSTEMI

Variable STEMI

(n=23,230) NSTEMI

(n=35,475) Qualifying Criteria ST-Segment Depression 23% Transient ST-Segment Elevation 2% Persistent ST Elevation 97% New LBBB 3% Presenting Characteristics Tachycardia 16% 23% Hypotension 6% 3% Signs of CHF 10% 20%

ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

In-Hospital Outcomes - STEMI vs. NSTEMI

Variable STEMI

(n=23,230) NSTEMI

(n=35,475) Death* 5.8% 3.9% Re-infarction 1.0% 0.9% CHF 6.5% 6.9% Cardiogenic Shock 6.2% 2.9% Stroke 0.8% 0.7% RBC Transfusion** 5.9% 7.9% Major Bleeding** 11.7% 9.7%

*Unadjusted mortality** Among non-CABG pts*Unadjusted mortality** Among non-CABG ptsACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

Non-CABG Major Bleeding and Transfusion –STEMI vs. NSTEMI

12%

10%

8%

6%

0%

5%

10%

15%

20%

Major Bleed Any RBC Transfusion

STEMI NSTEMI ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

Acute Medications - STEMI vs NSTEMI

98%93%

96%

68%

87%

95%88%

92%

40%

57%

0%

20%

40%

60%

80%

100%

ASA Beta Blockers Heparin(LMW+UFH)

GP llb-lllaInhibitors

Clopidogrel

STEMI NSTEMI ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

Discharge Medications - STEMI vs NSTEMI

98% 98%

88%

95%91%

97% 97%

84%89%

74%

0%

20%

40%

60%

80%

100%

ASA Beta Blockers ACE-I or ARB Statins Clopidogrel

STEMI NSTEMI ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009

Discharge Interventions – STEMI vs. NSTEMI

90%96%

84%

98%

88%94%

74%

97%

0%

20%

40%

60%

80%

100%

ExerciseCounseling

DietaryModification

Cardiac RehabReferral

SmokingCessation

STEMI NSTEMIACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009ACTION Registry-GWTG DATA: January 1, 2009 – December 31, 2009